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General NPI Number Information
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NPI Number | 1689893174
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Entity Type | Organization
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Legal Business Name | DRAPER FAMILY MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 12272 SOUTH 800 EAST SUITE A
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City | DRAPER
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State | UT
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Zip | 84020
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Country | US
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Telephone | 801-523-1300
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Fax | 801-523-1301
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Provider Business Mailing Address
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Address Line | 12272 SOUTH 800 EAST SUITE A
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City | DRAPER
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State | UT
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Zip | 84020
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Country | US
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Telephone | 801-523-1300
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Fax | 801-523-1301
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Authorized Official
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Title or Position | OWNER
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Name | CARLIE HAMILTON
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Credential | FNP
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Telephone | 801-523-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5668757-1205
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License Number State | UT
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